骨化三醇胶丸联合ARB改善IgA肾病的免疫功能及其疗效分析

Curative effect of calcitriol capsules combined with ARB to improve immune function of IgA nephropathy

目的观察骨化三醇胶丸联合血管紧张素Ⅱ受体阻滞药(angiotensinⅡreceptor blocker,ARB)对IgA肾病(immunoglobulin A nephropathy,IgAN)患者免疫功能的改善及疗效情况。方法选取2019年1月至2021年12月浙江大学医学院附属第二医院临平院区收治的86例IgA肾病患者,根据治疗方案不同分为缬沙坦组和厄贝沙坦组,每组43例。两组患者分别进行常规对症支持及饮食指导,缬沙坦组患者在常规治疗基础上给予骨化三醇胶丸和缬沙坦治疗,厄贝沙坦组患者在常规治疗基础上给予骨化三醇胶丸和厄贝沙坦治疗,均治疗3个月。根据治疗后尿蛋白含量及血压控制情况进行疗效评价,比较两组治疗总有效率。分别于治疗前和治疗后3个月留取两组患者晨起第1次小便后的24h尿液标本、晨尿标本以及空腹静脉血标本,测定24h尿蛋白定量、微量蛋白尿(microalbuminuria,MA)水平和T淋巴细胞亚群CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平。记录两组的不良反应发生情况。结果缬沙坦组治疗总有效率大于厄贝沙坦组,差异无统计学意义(P>0.05)。两组治疗后24h尿蛋白定量和MA均显著低于治疗前,差异均有统计学意义(P<0.05)。治疗后,厄贝沙坦组收缩压和舒张压均显著低于治疗前,差异有统计学意义(P<0.05),且厄贝沙坦组治疗后收缩压和舒张压显著低于缬沙坦组,差异有统计学意义(P<0.05)。两组治疗后CD4^(+)、CD4^(+)/CD8^(+)水平均显著低于治疗前,差异有统计学意义(P<0.05),但两组比较,差异均无统计学意义(P>0.05)。缬沙坦组不良反应总发生率显著低于厄贝沙坦组,差异有统计学意义(P<0.05)。结论骨化三醇胶丸联合缬沙坦或厄贝沙坦用于治疗IgAN均可取得良好的疗效,能够有效改善患者肾功能,提高免疫功能,其中厄贝沙坦在降压方面明显优于缬沙坦,而接受缬沙坦治疗方案的患者发生心血管不良事件的风险更小。

Objective To observe the effect of calcitriol capsule combined with angiotensinⅡreceptor blocker(ARB)on improving immune function of patients with immunoglobulin A nephropathy(IgAN)and compare its curative effect.Methods A total of 86 patients with IgAN treated in the Second Hospital of Zhejiang University Medical College Linping Branch from January 2019 to December 2021 were selected and divided into valsartan group and irbesartan group according to different treatment schemes,with 43 cases in each group.Patients in both groups were given routine symptomatic support and dietary guidance according to the situation.Patients in valsartan group were treated with calcitriol capsules and valsartan on the basis of routine treatment,while patients in irbesartan group were treated with calcitriol capsules and irbesartan on the basis of routine treatment,all of them were treated for 3 months.According to the urine protein content and blood pressure control after treatment,the curative effect was evaluated,and the total effective rate of the two groups was compared.Before treatment and 3 months after treatment,24-hour urine samples,morning urine samples and fasting venous blood samples were collected from two groups of patients,and 24-hour urine protein quantification,urine microalbuminuria(MA)level and T lymphocyte subsets CD4^(+),CD8^(+),CD4^(+)/CD8^(+)levels were measured.Adverse reactions were recorded during the treatment of the two groups.Results The total effective rate of valsartan group was higher than that of irbesartan group,but the difference was not statistically significant(P>0.05).The 24-hour urine protein quantification and MA were significantly lower than before treatment in both groups(P<0.05).After treatment,the systolic blood pressure and diastolic blood pressure in irbesartan group were significantly lower than those before treatment in both groups(P<0.05),and the systolic blood pressure and diastolic blood pressure in irbesartan group were significantly lower than those in valsartan group(P<0.05).After treatment,the levels of CD4^(+),CD4^(+)/CD8^(+)were significantly lower than those before treatment in both groups(P<0.05),but there was no significant difference between the two groups(P>0.05).The total incidence of adverse reactions in valsartan group was significantly lower than that in irbesartan group(P<0.05).Conclusion Calcitol capsules combined with valsartan or irbesartan can achieve good curative effect in treating IgAN,which can effectively improve patients'renal function and immune function.Irbesartan is obviously superior to valsartan in lowering blood pressure,while patients who receive valsartan have less risk of cardiovascular adverse events.